| NPI | 1235877572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0031417) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN.414809) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2024-04-18 |